Helping them adjust to a new home — the transition period

This article is for informational purposes only and does not constitute medical, legal, or financial advice. Please consult appropriate professionals for guidance specific to your situation.

The first weeks in a facility are disorienting for everyone. Your parent is in a strange place with strange people. The food tastes different. The bed is different. The lights are on different schedules. They wake up confused about where they are. They call for you. They ask when they're going home. For families, this is agonizing. Guilt crashes down in waves. You did this. You put them here. Every time they cry or seem confused or withdrawn, you think about how much safer and happier they'd be at home. You think about how you failed them.

What you need to understand is that this disorientation is temporary and normal. It's not a sign that you made a wrong decision. It's a sign that your parent is human and that everything about their life just changed dramatically. Adjustment takes time. Most people settle in within a few weeks to a couple of months. Some take longer. But initial distress doesn't mean permanent distress. It means adjustment is happening.

Your role during this transition period is different from your role as an ongoing family member at the facility. Right now, you're helping your parent transition. You're creating continuity between their old life and their new life. You're being a familiar presence in an unfamiliar place. But you're not solving the problem of their suffering. No one can. Your parent has to process a loss, and that's going to be uncomfortable and painful, and your presence can ease it but not eliminate it.

Rehabilitation Potential After Major Events

Before adjustment begins, understand what recovery might actually look like for your parent's specific situation. A hip fracture is different from a stroke. Heart surgery recovery is different from recovering from pneumonia. The potential for regaining function varies dramatically.

Hip fracture recovery in older adults usually follows a predictable arc. For the first month or so, your parent can't put weight on the affected leg. During weeks two through four, they're learning to bear partial weight with a walker. By week six or eight, many people are walking with a walker independently or with minimal supervision. Some get to a cane. Some plateau with a walker. Some never walk again, especially if they were frail before the fracture. The outcome depends partly on their pre-fracture function. Someone who was mobile and active before the fracture has better outcomes than someone who was already struggling to move around.

Stroke recovery is more unpredictable. In the first few days and weeks after a stroke, people sometimes make surprising gains. The brain has remarkable ability to rewire around injury. But that early window matters. Intensive therapy early produces better outcomes. By six months, most of the potential recovery has happened. After that, gains are still possible but slower. A stroke survivor might regain use of an arm, or speech, or the ability to walk. Some regain most function. Some regain some. Some regain very little. No one can predict which. It depends on the location and severity of the stroke, the person's age, their overall health, and their engagement with therapy.

Surgery recovery depends on what was done and why. A valve replacement or bypass surgery might take months to recover from, with gradual return of energy and function. A cancer surgery might remove the cancer but leave lasting limitations. A joint replacement might allow much greater function than before, or might be painful and restricted depending on how well the surgery worked and how the body heals.

Infection recovery also varies. Pneumonia in a previously mobile older adult might resolve with antibiotics and they return to baseline. Pneumonia in a frail older adult might be the beginning of decline. Urinary tract infections can cause temporary confusion that resolves with treatment. Some infections in older adults trigger a cascade of problems: delirium, falls, muscle loss, and permanent loss of function.

The point is that understanding your parent's specific situation and prognosis helps you manage both your expectations and your parent's expectations. What is realistic recovery for someone with your parent's specific condition, age, and baseline function? The doctor should be able to give you some sense of this. Not a guarantee. Not a timeline. But a sense of what's possible.

Emotional Reality of Plateau

Here's a truth nobody prepares you for: the moment when improvement stops is deeply difficult, even when you knew it was coming. Your parent has been in rehab for five weeks. They've made progress. They can do things they couldn't do when they arrived. But now the daily PT routine isn't producing visible gains anymore. The therapist mentions plateau. Suddenly discharge is being discussed. Your parent isn't going home completely recovered. Your parent is being discharged to go somewhere else, or to go home with significant limitations.

This is where grief enters the picture clearly. Your parent is grieving the loss of function. Your parent is grieving the life they had before the event. Your parent is mourning independence that won't come back. That grief is real and it's legitimate. And sometimes your parent expresses that grief by being depressed, withdrawn, angry, or refusing to participate in activities. These emotional responses are not personality flaws. They're responses to loss.

Your role is to allow grief without trying to fix it. You can't talk your parent out of being sad that they'll never walk without a walker again. You can't convince them that a walker is fine and life is still worth living. Those things might be true, but they don't erase the loss. What you can do is sit with your parent in the sadness. You can acknowledge it. You can say, "I know this is hard. I know you're grieving." You can let them feel what they feel without rushing to positivity or solutions.

The difficult part is that your parent's grief might express as anger toward you. Your parent blames you for putting them in the facility. Your parent resents the situation they're in. Your parent withdraws and won't talk to you. This doesn't mean you made a wrong decision. It means your parent is in pain and you're a safe target for that pain. It's not fair, but it's human.

During the plateau period, depression is also common. Your parent has been focused on recovery. They had something to work toward. Now there's nothing to work toward. They're staying in a facility indefinitely, or they're being discharged to a place they don't want to be. The future is bleak. Depression isn't a character flaw. It's a reasonable response to genuine loss. But it's also treatable. Talk to the facility doctor about your parent's mood. Ask about whether depression screening and treatment makes sense. Sometimes medication helps. Sometimes just acknowledging the depression and validating it helps.

Also understand that some of your parent's withdrawal or difficulty might be related to pain that's not being well managed. Is your parent in pain and not wanting to admit it? Is your parent medicated in a way that makes them drowsy and withdrawn? Is your parent dealing with constipation or other medication side effects that are affecting their mood? These are concrete problems with concrete solutions. Ask about them specifically.

When Rehabilitation Stops Working

The discharge plan gets developed during the plateau period. If your parent can manage at home with help, sometimes going home is an option. If your parent can't go home safely, somewhere else is the next step. Assisted living, group home, adult foster care, long-term nursing care, memory care if there's cognitive decline. The options depend on your parent's needs and your resources. It also depends on what placements are actually available in your area, which is a practical limitation many families don't anticipate.

This is often when family conflict emerges. You think your parent should go to assisted living. Your parent wants to go home. Your sibling who doesn't do the actual caregiving thinks you're being negative and pessimistic. Your parent's partner or spouse has opinions about what should happen. Everyone is emotionally exhausted and making consequential decisions under stress.

Try to approach discharge planning with clear-eyed assessment of what's actually possible and what's actually needed. Can your parent manage medications independently or with reminders? Can your parent get up and go to the bathroom safely? Can your parent prepare meals or feed themselves? Can your parent remember to eat if food isn't prepared? Can your parent manage hygiene and grooming? If your parent can do these things with minimal help, home might be possible. If your parent can't do them safely, home probably isn't possible, no matter how much everyone wants it to be.

Also factor in what family can realistically provide. Even if your parent could theoretically manage at home, are you able to provide the care? Are you working? Do you have health conditions? Do you have other family responsibilities? Are you willing to be on call at night? Are you able to handle medical emergencies? Can you lift your parent if they fall? These are practical questions that matter. Guilt will try to convince you that you should be able to do all of this. But actually, you can't do everything. Nobody can.

Sometimes celebrating progress and closure is what matters. Your parent has gone through a major medical event. They're no longer in danger of death or serious decline. They're stable. They're better than they were when they came into the facility. That's real progress. That's worth acknowledging. Even if it's not the progress you hoped for, it's progress.

How To Help Your Elders provides educational content for family caregivers. This is not a substitute for professional medical, legal, or financial advice. Every family situation is different; what works for one may not work for another.